MEDICARE: MRS. CHERYL G. FITZGERALD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	222Q00000X	Developmental Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760572432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHERYL G. FITZGERALD

Provider Business Mailing Address
First Line	:	14240 SAND PINE LN
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32409-2559
Country	:	US
Telephone Number	:	850-265-5152
Fax Number	:	850-265-5152

Provider Business Practice Location Address
First Line	:	14240 SAND PINE LN
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32409-2559
Country	:	US
Telephone Number	:	850-265-5152
Fax Number	:	850-265-5152

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	02/28/2013

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